Provider Demographics
NPI:1225792161
Name:MATTHEWS, NITIKA DARSHAE (LMSW)
Entity Type:Individual
Prefix:
First Name:NITIKA
Middle Name:DARSHAE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:GRADY
Mailing Address - State:AL
Mailing Address - Zip Code:36036-6206
Mailing Address - Country:US
Mailing Address - Phone:334-372-1307
Mailing Address - Fax:
Practice Address - Street 1:4720 WOODMERE BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3065
Practice Address - Country:US
Practice Address - Phone:334-676-6773
Practice Address - Fax:334-460-9721
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
AL4770G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional